Viability of general practice this winter in doubt, warns BMA

The viability of general practice this winter is in doubt because the vast majority of measures in the 'support package' published last week offer no new help to the profession, the BMA has warned.

BMA House (Photo: Malcolm Case-Green)
BMA House (Photo: Malcolm Case-Green)

BMA analysis of 29 measures set out in the package found that 19 either fail to offer support at all, or simply re-state existing policy. Three had 'potential to offer support, but not immediately', while the remaining seven offered limited support that would be far outweighed by the 'punitive approach that is being pursued', the analysis warned.

It comes as BMA GP committee leaders prepare for an emergency meeting to determine how the profession should respond to the package of measures, which offers £250m in funding for general practice linked to demands for more appointments and an increase in face-to-face access to GPs.

Polling by the BMA suggests more than half of GPs could be prepared to quit the NHS if the government failed to provide the support the profession needs.

GP crisis

BMA leaders are reported to have urged GPs not to engage with demands set out in the support package, despite warnings in the document that this could lead to contractual action.

An update sent to practices by Londonwide LMCs on 19 October said that 'the BMA’s GP committee has today advised GPs and practices not to engage in any activity associated with implementing NHS England’s so-called general practice support package'.

The document setting out the government and NHS England's 'plan for improving access and supporting general practice' makes clear that 'where practices do not engage with support and are in breach of their contractual obligation to meet the reasonable needs of their registered patients, appropriate contractual action will need to be undertaken'.

The BMA has called this threat 'completely unacceptable', warning it 'shows a lack of empathy for the strain GPs and practice staff are already under'. A blanket refusal by the profession to engage with the support package would plunge the BMA back into serious confrontation with NHS England, just weeks after its GP committee voted to restore formal talks with health service officials.

Support for GPs

The BMA analysis criticises the £250m winter access fund for expecting 'exhausted GPs and practice staff to work more', warning of the dangers attached to pushing the existing workforce to work 'longer and harder'.

It criticises plans to bring in doctors who are not GPs to work in general practice, warning the move raises a 'serious question about [the safety of] recruiting doctors that are not qualified to deal with undifferentiated care'.

The document hits out at NHS England and the DHSC for refusing to change how practices can access funding in the Investment and Impact Fund, or to reduce QOF requirements, while introducing new access requirements and adopting a 'name and shame approach' over face-to-face access.

It calls plans to target interventions at the 20% of practices providing the lowest numbers of appointments face-to-face 'just another stick to keep beating practices with'.

Overall, the BMA says the package increases the risk of general practice failing this winter. Its analysis says: 'Taken as a whole package, we do not believe this will provide meaningful additional support for general practice, enable any major impact for patient access, or provide any immediate desperatelyneeded support against aggression, abuse and violence against practices.

'As a result of this missed opportunity the government has increased the risk of general practice failing across entire localities this winter. Where general practice collapses the NHS collapses with it, and we must now fear for the viability of the entire service this winter.'

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